Implementation of a standardised annual anticoagulation specialist review in primary care

There are an increasing number of patients being prescribed direct oral anticoagulants (DOACs), while patients who remain on warfarin are becoming more complex. There is currently a lack of a standardised anticoagulation review for patients in primary care, resulting in potentially preventable harm events. Our aim was to implement a new service, where a standardised review is carried out by a specialist multidisciplinary secondary care anticoagulation team. Overall, implementation of a standardised review resulted in better optimisation of anticoagulation management for patients taking either a DOAC or warfarin. Out of 172 eligible patients prescribed warfarin, 47 (27%) chose to switch a DOAC. The average time in therapeutic range for patients on warfarin before and after the pilot increased from 73.5% to 75%. Out of 482 patients taking a DOAC, 35 (7%) were found to be on the incorrect dose. In 32 out of 35 patients (91%) the dose was amended after notifying the patient’s general practitioner. We also found a significant number of patients inappropriately prescribed concomitant medication such as antiplatelets or non-steroidal anti-inflammatory drugs, potentially putting patients at an elevated risk of bleeding. Whilst be it further research is needed; we believe the results of this pilot can be used to help build a case to influence commissioning of anticoagulation services. Secondary care anticoagulation teams, like our own, may be well placed to provide or support such services, working across the primary care: secondary care interface alongside our primary care colleagues.